AstraZeneca, 431 83, Molndal, Sweden.
Eur J Health Econ. 2010 Feb;11(1):5-13. doi: 10.1007/s10198-009-0145-6. Epub 2009 Mar 3.
This paper develops a welfare theoretic foundation for cost-effectiveness analysis (CEA) when survival is not affected. With this foundation, all costs and their corresponding utility-terms should be included. A key question, though, is whether these utility-terms are consistent with quality-adjusted life year (QALY) (utility) theory or not. The results show that health care costs and changes in the utility of health should be included. However, as QALYs do not capture the utility of changes in consumption (as this utility must be independent of health, according to QALY theory), the corresponding changes in consumption costs should be excluded. Regarding the costs for changes in absence from work, these should only be included if the utility of changes in the amount of leisure is included. As no QALY theory has been developed that includes this utility, it is unclear how to handle these costs (even if there are arguments for excluding them). For changes in productivity at work, though, there are robust arguments for the inclusion of these costs. Overall, it seems difficult to provide a clear basis for CEA in economic welfare theory when also including non-medical goods such as consumption and leisure.
本文为生存不受影响时的成本效益分析（CEA）建立了福利理论基础。在此基础上，应包括所有成本及其相应的效用项。不过，一个关键问题是这些效用项是否与质量调整生命年（QALY）（效用）理论一致。结果表明，应包括医疗保健成本和健康效用的变化。然而，由于 QALY 无法捕捉消费变化的效用（根据 QALY 理论，这种效用必须独立于健康），因此应排除相应的消费成本变化。关于缺勤成本的变化，只有在包括闲暇量变化的效用时，才应包括这些成本。由于没有制定包括这种效用的 QALY 理论，因此尚不清楚如何处理这些成本（即使有排除这些成本的理由）。不过，对于工作中的生产力变化，有强有力的理由支持包括这些成本。总体而言，当包括消费和闲暇等非医疗商品时，要在经济福利理论中为 CEA 提供明确的依据似乎很困难。
